Primary Contact Information

Specific Company Information

Description of Business/Product (Explain why it is a great opportunity for an investment.):
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Limit 100 words.
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Description of the greatest achievement of the founders in business:
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Limit 100 words.
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Company FOUNDER Information:
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Full Name

Equity Stake/Ownership (%)

Role/Expertise (e.g., business, technical, marketing, etc.)

Email Address

Phone Number

Company INVESTOR Information:

Investor Name

Investment Type (e.g., Equity, Convertible Note, SAFE, Other)

Investment Amount ($)

Investment Date

Equity Stake/Ownership Interest (%)

Current Company Cash Available ($):
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Name of Founder Working Full-time on the Company:
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First Name Last Name

Stage of Product Development:
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List Projected Milestones for next 12 - 18 Months:
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Target Milestone Description/Name

Funding Required ($)

Time required (Months)

Describe your Exit Strategy:
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Limit 100 words.
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Socially or Economically Disadvantaged Statement:
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Socially or economically disadvantaged refers to individuals whose ability to compete in the free enterprise system has been impaired because they generally do not have access to investment capital, are at a clear networking disadvantage, or are subject to being professionally marginalized. Clearly state why you consider yourself to be socially or economically disadvantaged. 100 Word limit.
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